title: Prediction scores do not correlate with clinically adjudicated categories of pulmonary embolism in critically ill patients.
abstract: BACKGROUND
  Prediction scores for pretest probability of pulmonary embolism (PE) validated in outpatient settings are occasionally used in the intensive care unit (ICU).
  
  
  OBJECTIVE
  To evaluate the correlation of Geneva and Wells scores with adjudicated categories of PE in ICU patients.
  
  
  METHODS
  In a randomized trial of thromboprophylaxis, patients with suspected PE were adjudicated as possible, probable or definite PE. Data were then retrospectively abstracted for the Geneva Diagnostic PE score, Wells, Modified Wells and Simplified Wells Diagnostic scores. The chance-corrected agreement between adjudicated categories and each score was calculated. ANOVA was used to compare values across the three adjudicated PE categories.
  
  
  RESULTS
  Among 70 patients with suspected PE, agreement was poor between adjudicated categories and Geneva pretest probabilities (kappa=0.01 [95% CI -0.0643 to 0.0941]) or Wells pretest probabilities (kappa=-0.03 [95% CI -0.1462 to 0.0914]). Among four possible, 16 probable and 50 definite PEs, there were no significant differences in Geneva scores (possible = 4.0, probable = 4.7, definite = 4.5; P=0.90), Wells scores (possible = 2.8, probable = 4.9, definite = 4.1; P=0.37), Modified Wells (possible = 2.0, probable = 3.4, definite = 2.9; P=0.34) or Simplified Wells (possible = 1.8, probable = 2.8, definite = 2.4; P=0.30).
  
  
  CONCLUSIONS
  Pretest probability scores developed outside the ICU do not correlate with adjudicated PE categories in critically ill patients. Research is needed to develop prediction scores for this population.
authors.forename: Christina
authors.initials: C
authors.lastname: Katsios
authors.forename: Marco
authors.initials: M
authors.lastname: Donadini
authors.forename: Maureen
authors.initials: M
authors.lastname: Meade
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.forename: Richard
authors.initials: R
authors.lastname: Hall
authors.forename: John
authors.initials: J
authors.lastname: Granton
authors.forename: Jim
authors.initials: J
authors.lastname: Kutsogiannis
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: Lauralynn
authors.initials: L
authors.lastname: McIntyre
authors.forename: Nikolas
authors.initials: N
authors.lastname: Vlahakis
authors.forename: John
authors.initials: J
authors.lastname: Muscedere
authors.forename: Jan
authors.initials: J
authors.lastname: Friedrich
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.forename: Yoanna
authors.initials: Y
authors.lastname: Skrobik
authors.forename: Martin
authors.initials: M
authors.lastname: Albert
authors.forename: Michael
authors.initials: M
authors.lastname: Cox
authors.forename: James
authors.initials: J
authors.lastname: Klinger
authors.forename: Joseph
authors.initials: J
authors.lastname: Nates
authors.forename: Andrew
authors.initials: A
authors.lastname: Bersten
authors.forename: Chip
authors.initials: C
authors.lastname: Doig
authors.forename: Nicole
authors.initials: N
authors.lastname: Zytaruk
authors.forename: Mark
authors.initials: M
authors.lastname: Crowther
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012189:Retrospective Studies